Session 9 Useful notes - Learn only if time/after ECG lectures are done

Question 1

Describe an alternative surgical treatment to stent placement (LEARN IF TIME)

Answer 1

Coronary artery bypass graft surgery

• Diverts blood around narrowed or clogged parts of major arteries, and provides an alternative route for blood to flow to improve blood flow and oxygen supply to heart

Question 2

Examination of suspected ACS (LEARN IF TIME)

Answer 2

• BP if systolic <90 - hypotensive could result in cardiogenic shock)
• Tachycardia - seen in fight or flight response. You will have that fight or flight response in a MI
• Bradycardia due to occlusion of right coronary artery, which supplies the SA node (2:1 heart block/complete heart block)
• JVP - if elevated, may indicate right heart failure or pulmonary oedema
• Heart murmur
• Lungs - clear or wet - wet with lots of crackles = large MI
• Cool peripheries? - shut down due to shock

Question 3

Assessment of suspected acute coronary syndrome (7) (LEARN IF TIME)

Answer 3

History:
- Cardiac sounding?
Squeezing, pressure pain?
- Radiation to neck/left arm/jaw?
- Relieved with GTN?
- How long have you had it?
- Is pain getting worse?
- Pleuritic? ie worse if you breath in - maybe you have a pulmonary embolism

Risk factors present? (eg diabetes, smoker, high cholesterol, family history, thrombophillia)

Question 4

What do we use echocardiogram for? (LEARN IF TIME)

Answer 4

LV function (normal or impaired)
Wall motion (regional or global motion)
Valvular disease (mitral regurg)
Complications from MI eg VSD - ventricular septal defect

Question 5

What does ST elevation imply? (LEARN AFTEER ECG)

Answer 5

• Sudden occlusion
• or can persist long term as a marker of LV aneurysm (Q waves usually present)

Question 6

What does ST depression imply? (LEARN AFTER ECG)

Answer 6

• Under supply of blood to myocardium but not sudden full occlusion
• If in anterior leads (V1-V6) can be due to posterior STEMI

Question 7

What does T wave inversion imply? (LEARN AFTER ECG)

Answer 7

• Under supply of blood to the myocardium but not sudden coronary occlusion
• There are other non-ischaemic related causes

Question 8

Describe the Evolution of waves in STEMI (LEARN AFTER ECG)

Answer 8

Hyperacute T waves + ST elevation (acute)
Q wave begins + ST elevation (hours)
T wave inversion + deeper Q wave (day 1-2)
ST normalise + inverted T waves (days)
ST and T normal, Q wave persists (pathological Q waves, weeks)